Hemostatic clip applicator

ABSTRACT

An applicator for hemostatic clips of unitary U-shaped construction. This applicator is formed with facing recesses in the jaws which are adapted to receive, retain and apply a hemostatic clip. The recesses are isolated from the rearward portion of the jaw faces by means of notches cut into the faces at the rearward end of the recesses.

United States Patent i 3,631,707

[72] lnventor Alphonse K- Mil 3,032,039 5/1962 Beaty 227/19 Merrick,N.Y. 3,270,745 9/1966 128/325 [21 1 Appl. No. 832,947 3,363,628 1/1968128/325 [22] Filed June 13, 1969 2,668,538 2/1954 128/346 [45] PatentedJan. 4, 1972 2,853,074 9/1958 Olson 128/325 [73] Assign grgig xg g i gPrimary ExaminerCharles W. Lanham Assistant Examiner-Michael J. KeenanAttorneys-Lawrence A. Maxham, Stanley M. Schurgin and [54] HEMOSTATICCLIP APPLICATOR Joseph weingarten 3 Claims, 11 Drawing Figs. [52] US. Cl72/410, M

128/325 [51] Int. Cl 821d 9/08 Field search-m- 2 ABSTRACT: An applicatorfor hemostatic clips of unitary U- 326,346; 227/19; 29/243.56; 72/410,40 shaped construction. This applicator is formed with facing recessesin the jaws which are adapted to receive, retain and [56] ReferencesCited apply a hemostatic clip. The recesses are isolated from the UNITEDSTATES PATENTS rearward portion of the jaw faces by means of notches cutinto 3,326,216 6/1967 Wood 128/325 the faces at the rearward end of therecesses.

PATENTEU JAN 41972 SHEET 1 [IF 2 INVENTOR.

ALPHONSE K. MILLER ATTo NEYS PATENIEU JAN 4 i972 SHEET 2 [1F 2 INVENTOR.ALPHONSE K. MILLER HEMOSTATIC CLIP APPLICATOR FIELD OF THE INVENTIONThis invention relates in general to mechanisms useful in thestrangulation of flexible tubular members and more specifically isdirected toward an applicator useful with hemostatic clips of specificconfigurations for the strangulation of fluid ducts such as bloodvessels in humans and animals.

DISCUSSION OF THE PRIOR ART In the course of a surgical operation, asurgeon must often sever one or more blood vessels, sometimes as many asseveral dozen. It is necessary to provide means for closing the ends ofsevered vessels, at least until the end of the operation, to stopbleeding which could interfere with the performance of the operation aswell as preventing unnecessary risk to the patient.

Conventionally, surgeons have used ligatures or the like tied about theindividual vessels at the desired point of strangulation. This requiresgreat dexterity and speed in order to tie off each blood vessel whilekeeping the surgery time within reasonable limits. More recently,however, hemostatic clips which are formed from a single strip ofdeformable nontoxic material into a substantially U-shape have been usedto quickly and efficiently strangulate blood vessels and other fluidducts. These hemostatic clips, in conjunction with a speciallyconstructed forceps-type applicator, have been described in U.S. Pat.No. 3,326,216 and No. 3,363,628, issued June 20, 1967 and Jan. 16, 1968respectively, to Ernest C. Wood. The invention disclosed herein is animprovement over the hemostatic clip applicator shown in the abovepatents.

The jaws of the applicators disclosed in the patents referred to abovewere formed with grooves having substantially perpendicular forward endsand rearward portions which simply became gradually shallower. Thetechniques required for manufacturing such devices were necessarilycomplicated and relative expensive. Furthermore, after extensive use ofthese prior applicators, it became apparent that disproportionatelylarge forces were required for the final increment of closure of thehemostatic clip. This was traced to the fact that a relatively largeamount of the material of the clip became crowded at the bending pointdue to the fact that the bend was sharp and the structure quite small.Moreover, this fact of crowding of material at the bend of thehemostatic clip resulted in a certain small factor of spring actionwhereby the clip tended to open slightly after the closing forces wereremoved. Although this was not generally detrimental to the closure offluid ducts, in certain instances this slight opening prevented completeand positive strangulation with the consequent danger that thehemostatic clip might accidentally be removed from the duct.

SUMMARY OF THE INVENTION It is a primary object of this invention toprovide an improved hemostatic clip applicator which is simple tomanufacture while providing positive and efficient closure of thehemostatic clips with which it is intended to operate.

Broadly speaking, the novel applicator of this invention comprises twopivotally joined elongated members having cooperating jaw portions onone side of the pivot and cooperating handle portions on the oppositeside. Means are provided to resiliently urge the jaw portions away fromeach other between certain limits. The jaw portions are specificallyformed to receive a hemostatic clip of generally U-shaped configurationand to tightly close the same about a fluid duct, generally referred toherein as a blood vessel, while avoiding the problem of crowding of thematerial of the clip together at the point of bending. The results ofthe use of this applicator with the hemostatic clips described andclaimed in US. Pat No. 3,363,628 and U.S. Pat. No. 3,326,216 are thatthe hemostatic clips are properly and fully closed through the use ofreduced closing forces and with substantially no tendency to spring openupon release of the applicator after closure. In addition, theapplicator constructed in accordance with the principles of thisinvention is simpler and more economical to manufacture than are theapplicators disclosedin theabove patents.

BRIEF DESCRIPTION OF THE DRAWING The features and advantages of thisinventionwill be readily understood whenthe detailed description thereofis-read inv conjunction with the drawing wherein:

FIG. 1 is a plan view of a hemostatic clip applicatoriconstructed inaccordance with the principles of this invention;

FIG. 2 is an elevational view of the applicator of FIG. 1-;

FIG. 3 is an enlarged perspective view. of one of the jaws oftheapplicator of FIG. 1;

FIG. 4 is an enlarged sectional view of one of the jaws of theapplicator of FIG. 1;

FIG. 5 is a view of a portion of the resilient handle separating meansshown in FIG. I;

FIG. 6 is a perspective view of a magazine adapted to hold a pluralityof hemostatic clips configured to cooperate with the applicator of FIG.1;

FIG. 7 is a sectional view similar to FIG. 4. together with a section ofthe magazine of FIG. 6 showing the applicator jaws in relation to themagazine just prior to removal of a hemostatic clip therefrom;

FIG. 8 is a sectional view similar to FIG. 7 after removal of the clipfrom the magazine showing the hemostatic clip at its initial point ofclosure;

FIG. 9 is a sectional view similar to FIG. 8 showing the hemostatic clipwhich has completely closed upon a blood vessel;

FIG. 10 is an enlarged perspective of the closed blood vessel of FIG. 9;and

FIG. 11 is a perspective of the hemostatic clip of FIG. 10 without theblood vessel between the arms thereof.

DESCRIPTION OF THE PREFERRED EMBODIMENT With reference to the drawingand more particularly to FIGS. 1 through 5 thereof, the details of ahemostatic clip applicator constructed in accordance with the principlesof this invention are shown. The applicator is referred to generally byreference numeral 21 and comprises elongated member 22 rotatably securedto complementary elongated member 23 by means of pivot 24. Elongatedmember 22 is formed with handle portion 25 and jaw portion 26 whileelongated member 23 is formed with similar handle portion 27 and jawportion 28. The respective jaw portions cooperate to engage, retain andapply a hemostatic clip as described below. Handle portions 25 and 27,and consequently jaw portions 26 and 28 are forced apart within specificlimits by resilient member 31 which is secured to handle portion 23 bysuitable means such as screw 32 and is removably and slidably secured tohandle member 25 by means of hook 33. The operation of this resilientmember will be discussed in further detail below.

Referring now to FIGS. 3 and 4, it may be seen that jaws 26 and 28 aresimilarly constructed, having cooperative face portions, and thereforeonly jaw 26 will be described in detail. Jaw 26 generally comprises body34 and lip 35. Lip 35 is disposed at an angle with respect to body 34and has parallel sides, as is best shown in FIG. 2. The face of the lipportion of jaw 26 is formed with a forward ridge 36 and notches 37, 38separated by land 41. Land 41 has a groove .42 and planar surfaces 43.Although groove 42 is shown having a V-shaped cross section, it may haveany suitable cross section to fit a specific type of hemostatic clip. Itcan be seen in FIG. 3 that notches 37, 38 are deeper than groove 42. Thedetails of the function of this construction will be discussed below.

The specific hemostatic clip described and claimed in US. Pat. No.3,363,628 is shown in FIGS. 6 through 11. FIG. ,6 shows a magazine 44having several hemostatic clips 45 stored therein for easy access foruse with applicator 21. In FIG. 7 jaws 26 and 28 are shown in engagementwith clip 45which is still seated in a groove in magazine 44 just priorto removal therefrom. As the clip and applicator are removed frommagazine 44, the clip is retained between the applicator jaws as shownin FIG. 7 due to the biasing action of resilient member 31. The clip isthen in condition to be applied to a blood vessel for purposes ofclosing it to stop the further flow of blood therethrough. In FIG. 8 thejaws of applicator 2! are shown to have been closed slightly from theposition shown in FIG. 7. Because of the specific configuration of thelips of the jaws and the cooperating shape of the hemostatic clip, thepreviously separated ends of clip 45 have come together to form a closedsemielliptical opening between the arms of the clip. If, prior to theinitial closing step shown in FIG. 8, the clip had been positionedaround a blood vessel 46, the blood vessel would then be fully enclosedbetween the arms of the hemostatic clip as shown, and there would be notendency, when the clip is completely closed, for the blood vessel toslide forward within the clip or to in any way escape from between thearms thereof. In FIG. 9, the hemostatic clip is shown completely closedabout blood vessel 46, thereby preventing further flow of bloodtherethrough. Although the ends of clip 45 have again become separated,blood vessel 46 is tightly and positively held between the straight andnearly parallel arms of the clip.

With specific reference to FIGS. 9, l and 11, it is readily apparentthat rearward notches 38 in the applicator jaws cooperate with thefolded end 47 of clip 45 to allow that end to asume a naturalconfiguration upon complete closure of the clip. That is, instead offorcing the clip to make a sharp, extremely tight bend whichsubstantially deforms and crowds the material, the inside of the bend isallowed to remain somewhat rounded and material deformation issignificantly reduced. By allowing end 47 of the hemostatic clip toenter notches 38 while the arms of the clip are forced together,hemostatic clip 45 can be closed with considerably less force than wouldbe necessary in the absence of notches 38.

From the above description it may be seen that the applicator of thisinvention causes the hemostatic clip shown in the drawing to fullysurround the blood vessel before closing upon it, and to safely,positively and efiiciently strangulate the blood vessel with arelatively small amount of closing force while reducing any tendency ofthe hemostatic clip to spring apart after the closing force has beenremoved. It can readily be appreciated that the manufacture of the lipsof the applicator having a groove 42 is greatly simplified by formingnotches 37, 38 at each end of the groove. Without such notches it wouldbe necessary for the groove to have at least a forward vertical wall inorder to properly engage and retain the hemostatic clip, which isprovided by the flat rearward wall of ridge 36 as shown in the drawing.

Although forward notches 37 serve to simplify the manufacture of theapplicator herein described, they are not essential to the inventionsince they serve no purpose in grasping or closing hemostatic clips.Conversely, rearward notches 38 cooperate with groove 42 and hemostaticclip 45 to make the closure of such clips more efficient and positive.If desired for any purpose, notches 37 may be omitted from theapplicator jaws and groove 42 will then end in a perpendicular wall atridge 36.

The construction and function of resilient member 31 may be readilydescribed with reference to FIGS. 1, 2 and 5. Resilient member 31 isshown as a spring-steel band which is fixed to handle 27 by suitablemeans such as screw 32, and bears against the opposite surface of handleto force the handles apart. In order to restrict the distance whichhandles 25, 27 are biased apart, resilient member 31 is formed with anopening 51 having a rearwardly extending slot 52, the transition betweenopening 51 and slot 52 providing lateral shoulders which removablyengage hook 33 on handle 25. This prevents the handles and jaws ofapplicator 21 from being unintentionally separated a greater distancethan is required for lips 35 to firmly engage hemostatic clip 45 inmagazine 44. The biasing action of member 31 maintains sufficientpressure upon the clip by jaws 26, 28 so that it is retained by the appicator after removal from the magazine. However, in order to facilitateseparation of the applicator handles by a greater distance for suchpurposes as sterilizing and cleaning the jaws, member 31 is madesuitably flexible and slot 52 is appropriately wide so that it may beopened sufficiently to allow hook 33 to pass through it merely bysubstantially increasing the forces which tend to urge the handlesapart. Thus, resilient member 31 is so constructed that, in normaloperation, it urges the handles apart a predetermined distance butprevents their unintentional separation by a greater distance, while atthe same time it permits the handles to be further separated by theexertion of an increased separating force causing resilient member 31 tobecome disengaged from book 33.

The foregoing is a complete description of a preferred embodiment of ahemostatic clip applicator constructed in accordance with the principlesof this invention. It is likely that changes and modifications willoccur to those skilled in this art which are within the inventiveconcepts disclosed herein.

What is claimed is:

1. A surgical instrument adapted to engage, retain and apply a U-shapedhemostatic clip of the type having substantially parallel, normallyseparated arm portions interconnected at one end thereof and beingadapted to strangulate fluid ducts in the body, said instrumentcomprising:

a first elongated member formed with a handle portion and a jaw portion;

a second elongated member formed with a handle portion and a jawportion;

said first elongated member being adapted to cooperate with said secondelongated member so that said jaw portions may operate upon saidhemostatic clip; and means for pivotally connecting said first andsecond elongated members together intennediate their respective handleand jaw portions so that said handle portions may be cooperativelymanipulated to open and close said jaw portions;

said jaw portions having confronting faces, said faces beingsubstantially parallel when said jaws are closed, each said face beingformed with a longitudinal groove adapted to receive said arm portionsin said normally separated condition, a transverse notch across saidface rearward of said groove and extending into said face a distancegreater than the depth of said groove, and a transverse wall at theforward end of said groove substantially perpendicular to the plane ofsaid face, thereby providing an abutment for the end of one arm of saidhemostatic clip when said arm is seated within said groove, said groovebeing shorter than said hemostatic clip so that upon closure of saidhemostatic clip by positive displacement of said jaw portions towardeach other to deform said hemostatic clip, the outer extremities of saidarms are displaced to a position closer together than the outerextremities of said interconnecting end of said hemostatic clip, saidinterconnecting end remaining rounded and extending substantiallynormally to the plane of said face into said notch.

2. The surgical instniment recited in claim 1, wherein:

said face is further formed with a transverse notch across said faceforward of said groove and rearward of said transverse wall.

3. The surgical instrument recited in claim 1, and further comprising:

resilient means for biasing said handle portions a predetermineddistance apart; and

means for normally preventing said handle portions from separating by anamount greater than said predetermined distance.

1. A surgical instrument adapted to engage, retain and apply a U-shapedhemostatic clip of the type having substantially parallel, normallyseparated arm portions interconnected at one end thereof and beingadapted to strangulate fluid ducts in the body, said instrumentcomprising: a first elongated member formed with a handle portion and ajaw portion; a second elongated member formed with a handle portion anda jaw portion; said first elongated member being adapted to cooperatewith said second elongated member so that said jaw portions may operateupon said hemostatic clip; and means for pivotally connecting said firstand second elongated members together intermediate their respectivehandle and jaw portions so that said handle portions may becooperatively manipulated to open and close said jaw portions; said jawportions having confronting faces, said faces being substantiallyparallel when said jaws are closed, each said face being formed with alongitudinal groove adapted to receive said arm portions in saidnormally separated condition, a transverse notch across said facerearward of said groove and extending into said face a distance greaterthan the depth of said groove, and a transverse wall at the forward endof said groove substantially perpendicular to the plane of said face,thereby providing an abutment for the end of one arm of said hemostaticclip when said arm is seated within said groove, said groove beingshorter than said hemostatic clip so that upon clOsure of saidhemostatic clip by positive displacement of said jaw portions towardeach other to deform said hemostatic clip, the outer extremities of saidarms are displaced to a position closer together than the outerextremities of said interconnecting end of said hemostatic clip, saidinterconnecting end remaining rounded and extending substantiallynormally to the plane of said face into said notch.
 2. The surgicalinstrument recited in claim 1, wherein: said face is further formed witha transverse notch across said face forward of said groove and rearwardof said transverse wall.
 3. The surgical instrument recited in claim 1,and further comprising: resilient means for biasing said handle portionsa predetermined distance apart; and means for normally preventing saidhandle portions from separating by an amount greater than saidpredetermined distance.